Healthcare Provider Details

I. General information

NPI: 1205519782
Provider Name (Legal Business Name): DANIEL JOSEPH MUCERINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAN JOSEPH MUCERINO ND

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 NE 25TH ST APT 1207
MIAMI FL
33137-5081
US

IV. Provider business mailing address

162 NE 25TH ST APT 1006
MIAMI FL
33137-5078
US

V. Phone/Fax

Practice location:
  • Phone: 954-529-7780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: